CHOICES

HOW DO I CHOOSE? 
WAYS TO THINK ABOUT STEM CELL
OPTIONS

ONE: LIVE BIRTH UMBILICAL CORD TISSUE-DERIVED STEM CELL EXTRACTION

Part of the controversy surrounding stem cell replacement, pounced on by the media, is the idea that stem cells must be retrieved from human embryos or specifically the umbilical cord, which has raised ethical concerns. But the reality is that all approved therapies in the United States do NOT include cells harvested from fetal tissue and are either performed using adult stem cells or those collected from donated (and otherwise typically discarded) umbilical cords of successful healthy births. When using allogeneic cells, you don’t have to endure harvesting stem cells from your own tissues, since they come from donors. Until recently, these cells have been obtained from blood or bone marrow of qualified and screened donors. More recently, mesenchymal stem cells harvested from donated umbilical cord tissue are being used for allogeneic stem cell treatments. This is a huge advantage for those that do not have time to go through the harvesting process or cannot because of injury or for other reasons. 

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TWO: BONE MARROW-DERIVED STEM CELL EXTRACTION

Bone marrow aspiration is a surgical procedure where a patient is given anesthesia (either general or local) while the doctor uses specialized, hollow needles to "tap" and withdraw liquid marrow from one or both sides of the back of the pelvis. While the incisions are typically less than a quarter of an inch long and do not require stitches, this is still a procedure that some are unable to tolerate. Bone marrow aspirations can make you feel like you fell off your bike and landed on your hip, but the real problem is that the number of cells that can be harvested can vary and is limited in both quantity and types. With bone marrow aspirations, the mix of three stem cells types (endothelial, mesenchymal, and hematopoietic) may serve better than just mesenchymal, but these aspirated stem cells cannot be expanded in the lab to produce even more, which may be useful, if not necessary.

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THREE: ADIPOSE-DERIVED STEM CELL EXTRACTION

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Yet another approach that currently has much broader applications and appeal in the stem cell community involves extracting mesenchymal stem cells from body fat through liposuction. As you’ll recall, mesenchymal stem cells are multipotent, which is to say, limited in their capacity to differentiate into certain types of cells. But to scientists’ surprise, recent research shows that the cells appear more flexibly mutable than previously thought. These cells don’t have to come from a donor, but can be obtained autologously, ensuring that the cells will most likely engraft and eliminating the chance that they might be rejected or introduce a foreign disease. Mesenchymal stem cells obtained from one’s own fat provide a means to harvest and expand far more stem cells in the lab than other techniques and, along with allogeneic umbilical-derived mesenchymal cells, currently appear to be the most efficient and ubiquitously useful of all stem cells. Adding the opportunity to bank fat-derived stem cells for future use further supports their efficiency and usefulness for cellular therapies requiring multiple treatments over time or for wellness applications as we age.

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FOUR: Blood-DERIVED STEM CELL EXTRACTION

Apheresis—or, more specifically, leukapheresis—is a process by which catheterization and a centrifuge are used to extract the stem cells from blood. While certainly not as painful as a bone marrow aspiration, the procedure is time consuming (usually four to six hours) and involves sitting with catheters in each arm while a machine draws blood from one arm, separates the white blood cells (those containing the stem cells) using a centrifuge, and then replaces the remainder via the opposite arm. An additional time burden is that, unlike aspiration, apheresis patients require injections of a granulocyte-macrophage colony-stimulating factor (GM-CSF), a drug that ramps up the body’s production of stem cells, that must be performed daily for three to five days prior to apheresis in order to mobilize stem cells from the bone marrow into the blood for harvesting.